Anxious Mind, Skin Flare-Ups: Psychodermatology and the Stress-Skin Connection

How’s your skin doing lately? The answer to this question may be able to tell you more than you realize. 

That’s because your skin is intricately connected to your gut, your immune system, your hormones, and, as we’ll zoom in on today, your brain and mental health. I often think of your skin as being a window into what’s going on internally. 

A large body of research links the skin and the mind, and with my patients at my functional medicine telehealth center, I see this connection every day. 

Let’s take a look at how mental health, anxiety, and stress can influence your skin, how your skin can in turn influence your mind, the underlying factors that contribute to both brain and skin concerns, and what you can do to support both your skin and your mind holistically. 

What is Psychodermatology? 

Psychodermatology is a field that explores the relationship between skin and psychological health. The term usually refers to a subset of dermatology where practitioners focus on how emotional health impacts skin health. This impact is significant and widespread: research shows that more than one third of dermatology patients require consideration of psychological factors for effective management of their disease. (1) 

But as we’ll explore below, the relationship goes both ways, and practitioners of all kinds can use psychodermatological research and knowledge to help them work with patients from a whole-person health perspective. 

How Your Mind and Skin Are Connected

The skin and the mind are connected in multiple different ways. While we often think of the skin as being external and separate from the body, in reality it’s the body’s largest organ, both informing and responding to what’s going on internally. 

For example, inflammation that may begin in the gut can lead to nervous system inflammation and inflammatory skin conditions. External stressors can also permeate the skin, and trigger or exacerbate internal inflammation. 

Here’s what the research says about some of the biggest connections between skin and the brain. 

The Stress-Skin Connection

Chronic stress increases levels of inflammatory cytokines such as IL-6, which can trigger autoimmune and inflammatory skin conditions like psoriasis. (2) A major traumatic event or period of ongoing stress often precipitates psoriasis and other autoimmune conditions. (3) Stress also disrupts cortisol levels and overall hormonal balance, which can contribute to other chronic skin conditions including acne, as well as premature aging (in part by weakening collagen and elasticity). 

The skin also produces its own signals in response to stress and sends these back to the brain, creating a feedback loop. 

The Neuro-Immune-Cutaneous-Endocrine Model 

This model explores the communication network and connections between not only the skin and the brain but the skin, brain, immune system, and endocrine (hormonal) system. (1) Disruptions throughout the network can influence all components. 

As one example, activation of mast cells (a type of immune cell that releases inflammatory compounds like histamine in response to stress) has been shown to significantly influence the initiation and progression of inflammatory skin conditions including urticaria (hives) and atopic dermatitis. 

The Role of the Epidermal Barrier 

The epidermal barrier is the top layer of skin, which helps to protect us from harmful microbes and irritants. When this barrier is disrupted, harmful substances are more likely to get through, which can contribute to or flare skin conditions and inflammation throughout the body. 

Psychological stress is one major factor that can disrupt the integrity of the epidermal barrier, which can then trigger inflammatory skin conditions including psoriasis and atopic dermatitis (eczema). (4, 5) 

The Brain-Skin Axis 

This term describes the bidirectional relationship between the brain and the skin, and it essentially summarizes all of the different connections we’ve looked at so far. (6) Anything that disrupts skin health can make its way to the brain through an intricate network of connections, and vice versa. 

Conditions Influenced By the Mind-Skin Connection

Researchers have proposed a few different ways to categorize conditions influenced by the mind-skin connection. A widely used system includes three groups: psychophysiologic disorders, psychiatric disorders with dermatologic symptoms, and dermatologic disorders with psychiatric symptoms. (7) There are also many cases that fall somewhere outside of these buckets. 

Psychophysiologic Disorders

Psychophysiologic disorders, or more specifically psychodermatological disorders, are skin conditions in which psychiatric factors, including emotional stress and anxiety disorders, significantly influence the severity and course of disease. Disorders that fall into this category may include psoriasis, atopic dermatitis, rosacea, acne, lichen simplex, and alopecia areata, among others. 

Psychiatric Disorders With Dermatologic Symptoms 

These are conditions that are mainly characterized as psychiatric, but which involve dermatologic symptoms. An example would be obsessive compulsive disorders, which may involve scratching or skin picking, leading to skin lesions. Dermatitis artefacta, body dysmorphic disorder, delusions of parasitosis, and trichotillomania also fall into this category. 

Dermatologic Disorders With Psychiatric Symptoms

This category includes conditions that are primarily characterized as skin conditions, but which can lead to psychiatric symptoms such as anxiety, low self-esteem or body image issues, or depression. Chronic eczema, severe acne, and vitiligo may fall into this category. 

Overall, many mental health conditions are more common among those with skin disorders than among those without. A large European study found that 10% of dermatological patients also had depression (compared with 4.3% of those without dermatological conditions). Roughly 17% of patients reported anxiety. (8) 

The Broader Landscape of Mind-Skin Connections

These categories are helpful (especially within a dermatology practice) but imperfect. In my functional medicine practice, for example, I work with a lot of patients who don’t really fall neatly into one of these containers. 

What I see most often is someone with an underlying issue (such as a gut microbiome imbalance, systemic inflammation, and/or a hormonal imbalance) that triggers or exacerbates skin conditions, mental health conditions, and often other symptoms. When we work to heal that underlying imbalance, we often see major improvements in both skin and mental health. 

How To Support Skin and Mental Health 

While every individual case is different, there are several things you can do to support overall skin health and mental wellbeing, and improve your quality of life. I’ll be focusing on more holistic, root-cause focused, functional medicine approaches here. 

• Prioritize stress management. Having a regular mindfulness or stress management practice is essential when it comes to keeping chronic stress and its effects at bay. Breathwork, journaling, meditation, nature walks, and yoga or a few common practices that many people find effective, but you can choose anything that you find helps calm your nervous system. The key is to make it a regular practice, even if it’s only a few minutes a day, rather than to wait until you feel totally exhausted or burned out before you turn towards it. READ MORE: The Most Effective Ways To Manage & Reduce Stress In Your Life
  
• Eat an anti-inflammatory diet. What you eat is one of the biggest factors affecting your skin, your mental health, your cognition, your gut health, your hormonal health, and beyond. When you consistently eat to reduce inflammation and support overall health, you will likely notice the positive effects across these areas. READ MORE: Your Guide To The Anti-Inflammatory Diet
  
• Support your gut microbiome. The gut is intricately connected to the brain, the skin, the hormones, and everything else. Reducing inflammation and supporting microbiome balance within the gut helps to reduce inflammation throughout the body, and may support the balance of the skin microbiome. A good place to start is with a high quality probiotic supplement, in addition to your anti-inflammatory diet. READ MORE: How To Heal Your Gut: A Functional Medicine Guide To Restoring Microbiome Health
  
• Choose clean, non-toxic skincare products. We want to address the internal, but we also don’t want to ignore the external. Whatever you put on your skin influences the health of your skin barrier and skin microbiome, and can contribute to or calm inflammation. I always recommend looking closely at the ingredients in your topical skincare products, and choosing brands that are passionate and transparent about what they use. READ MORE: The Daily Skincare Routine, Rituals + Products Of This Functional Medicine Expert For Youthful, Glowing Skin 

Counseling, psychotherapy, or cognitive behavioral therapy can also be extremely helpful for individuals dealing with mental health symptoms or psychiatric conditions, with or without dermatological symptoms. 

Conventional providers may also prescribe selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, anti-anxiety medications, or antipsychotic medications depending on an individual’s condition. 

READ NEXT: Your Complete Functional Medicine Guide: To Clear Glowing Skin 

Everything Is Connected

Whenever you explore one connection within the body, you’re likely to find another. While I’ve been discussing the mind-skin connection and psychodermatology specifically here, I couldn’t even cover the basics without getting into additional connections involving the gut, the endocrine system, and the immune system. That’s because everything throughout the body (including the brain and the skin!) really is connected. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

• Jafferany, M. (2025). Special Report: Psychodermatology: Bridging Dermatology and Psychiatry.
• Biazus Soares, G., Mahmoud, O., Yosipovitch, G., & Mochizuki, H. (2024). The mind–skin connection: A narrative review exploring the link between inflammatory skin diseases and psychological stress. Journal of the European Academy of Dermatology and Venereology, 38(5), 821-834.
• Al’Abadie, M. S., Kent, G. G., & Gawkrodger, D. J. (1994). The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. British Journal of Dermatology, 130(2), 199-203.
• Orion, E., & Wolf, R. (2012). Psychological stress and epidermal barrier function. Clinics in dermatology, 30(3), 280-285.
• Garg, A., Chren, M. M., Sands, L. P., Matsui, M. S., Marenus, K. D., Feingold, K. R., & Elias, P. M. (2001). Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Archives of dermatology, 137(1), 53-59.
• Arck, P. C., Slominski, A., Theoharides, T. C., Peters, E. M., & Paus, R. (2006). Neuroimmunology of stress: skin takes center stage. Journal of Investigative Dermatology, 126(8), 1697-1704.
• Jafferany, M. (2007). Psychodermatology: a guide to understanding common psychocutaneous disorders. Primary care companion to the Journal of clinical psychiatry, 9(3), 203.
• Dalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., Jemec, G. B., … & Kupfer, J. (2015). The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. Journal of Investigative Dermatology, 135(4), 984-991.